Voters oppose clinics but value public health
June 1, 2000 3 minutes read
Voters oppose clinics but value public health
Support grows with understanding
Most people don’t understand the meaning of "public health," but when the phrase is explained to them, they support public health’s function wholeheartedly and want to spend more money to strengthen it, say researchers.
To really get people’s attention, researchers add, public health proponents should use phrases such as "emerging infectious diseases" and "environmental pollution" — both hot-button issues that voters say they are worried about.
Those were among the findings in a recent report on what the public thinks about public health. Study collaborators included the Pew Environmental Health Commission at Johns Hopkins School of Public Health in Baltimore and two Washington, DC-based polling firms: Public Opinion Strategies and the Mellman Group.
"Most people simply don’t understand the phrase public health,’" says Shelley Hearne, DrPH, executive director of the Pew Environmental Health Commission. "But once they get it, they’re very passionate about it."
Lack of support hinders prevention
A sample of registered voters was given a multiple-choice question that supplied five possible definitions of the phrase "public health," says Hearne. Three answers were correct (or nearly so): "programs and policies that prevent diseases for all of society," "programs that maintain healthy living conditions," and "programs that protect populations from disease."
Then there were the wrong answers: "government-provided health care for all" and "health care for the poor, such as Medicaid and public-health clinics."
Guess which answers 57% of respondents chose? Needless to say, their choices — "government-provided health care for all" and "clinics for the poor "— don’t command a lot of respect, Hearne says. "They’re just not winners when it comes to public policy."
On the other hand, once poll-takers supplied a correct definition of public health, respondents said they wanted more of it and were willing to pay for it. Asked to rate how well the public health system was doing, 56% of respondents answered "only fair" or "poor." Asked how much they would pay for better public health, people gave even more emphatic answers. In every instance except education, public health won out when respondents were asked to pick which of two choices they’d prefer using their tax dollars to fund.
Thus, public health beat out road-building (80% to 9%), missile defense (73% to 17%), and even tax cuts (63% to 27%). By that gauge, only education was deemed more important than public health, Hearne says.
Several things help explain people’s confusion about what "public health" means, says Hearne. For one thing, when it’s carried out properly, it fades into the wallpaper, she points out. "When it’s doing a good job, public health is virtually invisible. Only when there’s a failure do people take notice."
Programs lack government, public support
A different reason for public health’s low profile stems from low levels of government support, coupled with high public health aspirations. The upshot is that public health "has become so diffuse, and has moved into so many fields, that in a sense it’s a mile wide and an inch deep," says Hearne. The result is a wide array of often underfunded programs the general public perceives as "those clinics that take care of poor people," she adds.
Scant government support can be attributed to a longstanding lack of enthusiasm in the United States for the entire subject of prevention, she says. "In this country, we’re not doing prevention the way we should be." Tellingly, the commission Hearne heads released a report last month on the rising epidemic of asthma, a field in which the bulk of research dollars has gone to find new treatments.
According to the asthma report, "by 2010, we’ll have a doubling of deaths by asthma and 29 million asthmatics in this country," Hearne says. "But they’ll all have very effective nebulizers."
Reference
1. Centers for Disease Control and Prevention. Public opinion about public health — United States, 1999. MMWR 2000; 49:258-260.
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